Expectancy-Value Theory in Persistence of Learning Effects in Schizophrenia: Role
of Task Value and Perceived Competency
Jimmy Choi*,1, Joanna M. Fiszdon2,3, and Alice Medalia1
2VA Connecticut Healthcare System, West Haven, CT;3Department of Psychiatry, Yale University School of Medicine, New Haven, CT
*To whom correspondence should be addressed; Herbert Pardes Building, Mailbox 100, Columbia University Medical Center, 1051
Riverside Drive, New York, NY 10032, USA; tel: 212-543-5579, fax: 212-543-5882, e-mail: Jc3110@columbia.edu.
Expectancy-value theory, a widely accepted model of mo-
tivation, posits that expectations of success on a learning
taskandthe individual value placed onthe task are central
determinants of motivation to learn. This is supported by
research in healthy controls suggesting that beliefs of self-
and-content mastery can be so influential they can predict
the degree of improvement on challenging cognitive tasks
even more so than general cognitive ability. We examined
components of expectancy-value theory (perceived com-
petency and task value), along with baseline arithmetic
performance and neuropsychological performance, as
possible predictors of learning outcome in a sample of
70 outpatients with schizophrenia randomized to 1 of 2
different arithmetic learning conditions and followed up
after 3 months. Results indicated that as with nonpsychi-
atric samples, perceived self-competency for the learning
task was significantly related to perceptions of task value
attributed to the learning task. Baseline expectations of
success predicted persistence of learning on the task at
3-month follow-up, even after accounting for variance
attributable to different arithmetic instruction, baseline
arithmetic ability, attention, and self-reports of task
interest and task value. We also found that expectation
of success is a malleable construct, with posttraining
improvements persisting at follow-up. These findings sup-
port the notion that expectancy-value theory is operative
in schizophrenia. Thus, similar to the nonpsychiatric pop-
ulation, treatment benefits may be enhanced and better
maintained if remediation programs also focus on percep-
tions of self-competency for the training tasks. Treatment
issues related to instilling self-efficacy in cognitive recov-
ery programs are discussed.
Key words: learning/motivation/cognition/dysfunctional
While there is much evidence for the direct effects of neu-
rocognition on functional outcomes in schizophrenia,1–5
new research suggests that this relationship may be par-
tially mediated by negative symptoms,6and in particular,
amotivation.7Consequently, both neurocognition and
motivation have received increased scrutiny as potential
treatment targets to enhance functional outcomes.7The
nature of the overlap between neurocognition and moti-
vation has begun to be explored more intensely, and spe-
cific hypotheses have been made about psychological
factors that may be causally related to these 2 variables.
One such hypothesis concerns the role of dysfunctional
performance beliefs. There is evidence that dysfunctional
or defeatist performance beliefs are related to the pres-
ence of negative symptoms in schizophrenia and that de-
featist beliefs may partially mediate the relationship
between neurocognition and negative symptoms such
as amotivation as well as the relationship between neuro-
cognition, learning, and functioning.8–10
From a cognitive behavioral perspective, it has been
suggested that task disengagement and withdrawal
from effortful activities may serve as a defense against
anticipated failure and critical evaluation11and that
this leads to attenuated verbal behavior (alogia), dimin-
ished drive (anergia), and hopelessness for change (apa-
thy). This is parallel to social learning theories of
motivation for achievement in normals. Perception of
self-competency has been a central constituent ofmotiva-
tion for learning and a strong predictor of high levels of
motivation in educational and treatment settings.12–14
Bandura15,16proposed a social cognitive model that fo-
cused on the role of perceptions of self-efficacy to engage
in effortful learning tasks (ie, confidence in the ability to
are the major determinant of (a) a person’s choice to
Schizophrenia Bulletin vol. 36 no. 5 pp. 957–965, 2010
Advance Access publication on July 15, 2010
? The Author 2010. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved.
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participate in a learning activity, (b) a person’s willing-
ness to expend effort if the learning becomes challenging,
and (c) possibly the degree of learning retention from the
activity. Eccles and her colleagues17have elaborated on
this social learning perspective and developed and tested
a model called ‘‘expectancy-value’’ where they link learn-
ing, achievement performance, and task engagement di-
rectly to perceptions of self-efficacy and task value. In
activity is influenced by task-specific beliefs, such as per-
ceptions of self-competency and task difficulty as well as
competency beliefs and assessing the interaction of self-
competency and the motivation or volition to diligently
pursue and complete a task.18
In terms of psychopathology, this expectancy-value
phrenia can be more intrinsically motivated to learn if
they value the tasks as meaningful and useful to reaching
their goals (utility value). When a learning exercise is seen
as having utility, in essence if it is perceived as helpful in
achieving personally relevant goals, the person may be
more intrinsically motivated to learn and possibly benefit
more from the learning task.19Taken together, the
emerging empirical literature on dysfunctional perfor-
mance beliefs and expectancy-value theory both center
on how improved self-efficacy may lead to better task en-
gagement, higher motivation for treatment, and greater
duration of learning effects. In an earlier report, we de-
tailed how changing learning task characteristics through
the use of personalization, contextualization, and choice
led to increased intrinsic motivation (IM) for the learning
task and how this motivational manipulation resulted in
greater task learning as assessed at the end of training.20
We also reported that baseline perceptions of self-
competency were significant predictors of task learning
at the end of training. In this follow-up report, we sought
to examine the role self-competency in the ‘‘persistence’’
important self-competency is to maintaining gains. In the
nonpsychiatric population, self-efficacy for learning is
a powerful predictor of retaining the lessons taught de-
spite the challenging nature of the task.21When con-
fronted with a difficult learning task that does not
present any obvious benefit to the person (eg, complex
arithmetic), beliefs about whether the material can be
learned are more important to learning outcome than
intellectual abilities or even prior knowledge of the
material. In the same manner, when patients with
schizophrenia are faced with demanding cognitive tasks
in a cognitive training program where remediation goals
and rewards are not readily apparent or internally repre-
a factor in treatment outcome beyond that explained by
elementary cognitive functioning.
We hypothesized that (1) perceptions of self-compe-
tency would be positively correlated with task value at-
tributed by the individual at all 3 assessment points
(expectancy-value theory), (2) baseline perceptions of
self-competency would be related to durability of learn-
ing effects at 3 month follow-up, and (3) self-competency
would be malleable over time, with posttraining changes
in self-competence persisting at follow-up. We also
sought to examine the specific contribution of these var-
iables, along with premorbid function and baseline neu-
rocognitive performance, to persistence of learning
Participants in the study were 70 outpatients, ages 21–55,
diagnosedwith schizophreniaor schizoaffectivedisorder,
enrolled in a computer-based arithmetic learning pro-
88 were screened and enrolled, 82 completed training and
posttesting, and 70 returned for 3-month follow-up. Par-
ticipants were recruited at the New York State Psychiat-
ric Institute in New York City and the VA Connecticut
Healthcare System in West Haven, CT. Prior to partici-
pation in the study, participants had to be psychiatrically
stable for at least 30 days, with no changes in psychotro-
pic regimen. Diagnosis was confirmed by the Structured
Clinical Interview for Diagnostic and Statistical Manual
of Mental Disorders, Fourth Edition Axis I Disorders.23
Any participants with significant auditory/visual impair-
ment, lack of fluency in English or medical illness known
to impair brain function, other than schizophrenia, were
excluded. Participants who met criteria for current sub-
stance abuse/dependence were also excluded, including
those with active substance abuse 30 days prior to intake.
A description of the study was given to all participants
who provided written informed consent in accordance
with each respective hospital Institutional Review Board.
gence for each participant was established at study intake
with the vocabulary subtest scaled score from the Wechs-
ler Adult Intelligence Scale-Revised24and the reading
subtest standard score from the Wide Range Achieve-
ment Test-Third Edition (WRAT-325).
Estimated premorbid intelli-
Pairs Version (CPT-IP26) was used to measure the ca-
pacity to sustain focus on critical information in an
attention-demanding visual environment. The CPT-IP
per second. The participant is instructed to respond as
The Continuous Performance Test-Identical
J. Choi et al.
quickly as possible by pushing a control button whenever
2 identical stimuli are presented simultaneously. Major
performance indices include number of correct responses
to target, false positives, random errors, and d-prime.
Attention was assessed at baseline, end of training,
and 3-month follow-up.
line, end of training, and 3-month follow-up using a 48-
item paper-and-pencil arithmetic test used by Columbia
University Teacher’s College to assess general arithmetic
ability in young adults. The test comes in 4 alternative
forms to address possible ‘‘training to test’’ effects and
evaluates the participant’s knowledge and calculation
skills in addition, subtraction, division, multiplication,
use of parentheses, and order of operations (eg, ‘‘(4 þ
5) 3 5 = __’’). Item responses were open-ended, with
the total number correct at each assessment ranging
from 0 to 60. Alternate versions of the arithmetic test
were used at each assessment point.
Arithmetic skill was assessed at base-
using the Enjoyment/Interest subscale score on the In-
trinsic Motivation Inventory for Schizophrenia Research
(IMI-SR27,28), a Likert-type self-report scale designed to
assess a participant’s subjective experience of an activity
specifically in an experimental setting. IM is generally
considered the impetus for an activity due to associations
with positive feelings or enjoyment for that activity.29
Thesubscaleassesses the participant’sinterest/enjoyment
for a given learning activity (ie, ‘‘I enjoyed doing this ac-
tivity very much’’), with higher scores indicative of
greater IM for the task. The subscale is highly associated
with germane constructs of motivation for health-related
behaviors, including perceived competency for attempting
challenging tasksand autonomoustreatmentengagement.
The subscale has 7 items and a previous report show that
the subscale possesses good internal consistency (alpha =
.95) and test retest reliability (intraclass correlation coeffi-
cient [ICC] = 0.74).28Task interest was assessed at
baseline, end of training, and 3 months. For baseline
assessment, the subscale was given at the halfway point
during the first learning session, once the participants
were familiar with the learning tasks, they would be doing
for the remainder of the training. For posttreatment, the
task interest subscale was given immediately following the
last learning session. For 3 month follow-up, the subscale
was giveninthe same mannerthe original scaledevelopers
assessed IM for a past learning task or an activity in nor-
mals.30,31Participants were briefly shown the respective
learning exercise and instructed to complete the question-
naire in the context of how they recall feeling about
attempting the mathematics lesson.
IM for the learning task was measured
task was measured using the Task Value/Usefulness sub-
Reported value attributed to the learning
scale score on the IMI-SR. The subscale measures the
perceived significance of the task to the participant (ie,
‘‘I think that doing this activity is useful,’’ ‘‘I would be
willing to do this again because it has some value to
me’’), with higher scores indicative of greater perceptions
of task utility. The subscale has 7 items, and a previous
report shows that the subscale possesses good internal
consistency (alpha = .91) and test retest reliability (ICC =
0.70).28Task value was assessed at baseline, end of
training, and 3 months, concurrently with the task inter-
est assessment and in the same manner.
(PCS32) was used to measure the participant’s self-com-
petency about completing and mastering the learning ex-
ercise. The PCS consists of 4 items on a 7-point Likert-
type scale ranging from ‘‘not at all true’’ to ‘‘very true’’
(ie, ‘‘I feel confident in my ability to learn the computer
program,’’ ‘‘I am able to achieve my goals in this pro-
gram’’), with higher scores indicative of greater feelings
of self-competency for the task. The questionnaire has
shown good validity and consistency in repeated studies
examining its factor loadings related to internalized mo-
tivation and interest and possesses excellent internal
consistency (alpha = .80–.94).32Self-competency was
assessed at baseline, end of training, and 3 months, con-
currently with the task interest and task value assess-
ments and in the same manner.
The Perceived Competency Scale
by the expanded Brief Psychiatric Rating Scale (BPRS),
an updated version of the original BPRS.33,34The ex-
panded BPRS is a 24-item, self-report measure which
quantifies the level and presence of psychopathology
to‘‘extremely severe.’’ Weparsedthe BPRSinto thestan-
dard 4-factor solution of the 24-item BPRS35(negative,
positive, agitation–mania, and depression–anxiety). ICC
between raters at the same site and between sites ranged
from 0.82 to 0.87. The BPRS was administered at base-
line, posttraining, and 3-month follow-up.
Psychiatric symptomatology was measured
Participants were randomly assigned to 1 of 2 instruc-
tional methods of computer-based arithmetic learning.20
Because the emphasis of the current report is on the per-
sistence of learning effects (without regard to instruc-
tional methods that may impact the degree of learning
gains), we collapsed the 2 groups into a single sample
for purposes of the present analyses. We do, however,
provide a brief description of the 2 groups here to allow
interpretation of the results in the context of the original
study. Participants were paid for participating in base-
line, posttraining, and follow-up assessments but not
Expectancy Theory and Persistence
for their participation in the arithmetic learning sessions
Arithmetic Learning Program.
a gage of direct domain-specific learning that allows
the researcher to quantify the degree of material absorp-
tion from a specific lesson or intervention. Learning
arithmetic (parentheses and order of operation) was
also specifically chosen as a learning exercise because it
is challenging for many people and it does not present
itself as having any obvious benefit or intrinsic reward
(similar to cognitive training tasks in remediation pro-
grams). The arithmetic learning game board consists of
a numbered line from 1 to 60, and the first player to reach
60 is declared the winner. In each trial, working memory
and executive ability are needed to combine 3 numbers
generated by the computer into a valid arithmetic expres-
sion. Participants employ arithmetic knowledge and
rect expression. The resulting value of the created expres-
sion is the number of spaces the participant can advance
on the screen. If the participant cannot provide a valid
arithmetic expression using the generated numbers, the
computer provides instructional feedback in the form
of a brief arithmetic lesson and offers the correct answer.
a correct answer is provided. Two equivalent versions of
this learning program were created for the original study,
one with and another without instructional variables se-
lectively manipulated into the learning process to target
task interest. Both arithmetic learning game versions had
identical feedback and lesson content and involved the
same fundamental procedure noted above. The program
used was a single player option where the participant
challenged the computer at varying levels of difficulty.
Following baseline testing on all measures, partici-
pants were randomly assigned to 1 of the 2 learning pro-
grams for 10 thirty-minute sessions, to be completed over
the lessons at their pace. A research assistant conducted 4
sessions a week where participants were allowed to come
in anytime during those sessions to work on the lessons.
Cognitive and symptom posttesting were completed
within 2 days of the last lesson by a research assistant
blind to the randomization while 3-month follow-up test-
ing was completed on average 92 days after posttesting.
As mentioned in the instrumentation section, the ques-
tionnaires (task interest, task value,and self-competency)
obtain baseline and then immediately following the last
session for postassessment. At follow-up, participants
were briefly shown their respective math learning pro-
gram to remind them of the task they had completed dur-
ing the intervention in order to fill out the questionnaires
on their perceptions of the task.
Distributions of scores were inspected for normality and
compared with relevant comparison groups for homoge-
neity of variance. The comparison of the efficacy of the
different learning interventions at posttesting is reported
elsewhere.20Here, we focus on self-competency for the
arithmetic task and the durability of learning effects after
targeted training for the entire sample. To assess hypoth-
self-competency—we conducted a set of cross-sectional
correlations between these variables at baseline, post-
treatment,and follow-up.To assess hypothesis 2—there-
examined baseline self-competency as an independent
variable for predicting arithmetic ability at 3-month
follow-up, also taking into account other potential base-
line predictor variables. In order to determine whether
premorbid cognitive function was related to learning per-
sistence and whether it should be included as a variable in
the analysis examining predictors of learning persistence,
we performed partial correlations between baseline Vo-
cabulary and WRAT-3 Reading scores and 3-month
arithmetic ability, controlling for baseline arithmetic
ability. Next, we conducted a hierarchical multiple re-
gression, with forced entry at each block based on an or-
der of entry previously reported between each construct
and arithmetic learning.20For the analysis of predictors
of 3-month arithmetic ability, learning condition was
interest, baseline task value, and finally baseline per-
ceived self-competency. To assess hypothesis 3—that
self-competency is malleable with continued effects
evident at 3-month follow-up—we compared baseline,
posttraining, and 3-month performance scores for
PCS. We also examined baseline, posttraining, and
3-month follow-up scores for all the other variables to
better characterize the pattern of changes in learning,
attention, symptoms, task interest, and task value. All
statistical tests were 2-tailed, and alpha was set at .05.
Attrition from baseline to 3-month follow-up was 20%,
leaving 70 subjects who completed all procedures includ-
ing 3-month follow-up (table 1). The sample took 15.17
(4.64) days on average to complete the 10 arithmetic ses-
sions. As shown in the correlation matrix (table 2), there
was a significant, positive cross-sectional correlation be-
tween perception of self-competency for learning arithme-
tic andtask value at all 3 timepoints (baseline, posttesting,
and 3 month). To explain the relationship of baseline var-
iables to persistence in arithmetic ability 3 months follow-
ing the end of training, we entered group assignment and
interest, and value subscales, and PCS into a hierarchical
J. Choi et al.
model, which partitions equally exclusive components of
the overall variance for each variable, explained a signif-
icant portion of the variance in the total number correct
on the arithmetic test at 3-month follow-up (R2= .51,
F[4,66] = 5.37; P = .001). The results of the regression in-
volving learning condition (step 1), baseline arithmetic
ability (step 2), baseline attention (step 3), baseline
task interest (step 4), baseline task value (step 5), and
baseline perceived self-competency (step 6) are presented
in table 3. In the first 5 steps, 50% of the variance is
explained. With the addition of PCS in step 6, an addi-
tional 9% of the total variance was explained, which was
a significant increase in R2from the previous step (R2
change= .09;significanceofR2change=.00).In thisfinal
the unique variance in 3-month arithmetic ability, pre-
senting evidence of the association between perceptions
of self-competency and learning persistence, even when
different arithmetic instruction methods and baseline
arithmetic ability, attention, and task interest and value
were controlled. Partial correlations between premorbid
Reading) and 3-month arithmetic score, controlling for
baseline arithmetic score, were not significant (r’s =
?.07 to .10, P’s > .27); therefore, these variables were
not included in this analysis examining predictors of
To examine whether self-competency was malleable
and whether any changes in this variable persisted at 3-
monthfollow-up, t-tests were conducted comparingbase-
posttraining to 3-month follow-up PCS scores. As can be
seen in table 4, there was a significant increase in PCS
scores from baseline to posttraining and from baseline
to 3-month follow-up (t’s = 2.85–3.14, P = .02–.03).
PCS scores did not significantly decrease from posttrain-
ingto 3-monthfollow-up (t = 0.82, P = .23).We also com-
pared baseline with posttraining 3-month follow-up
Table 2. Cross-Sectional Correlations between Measures for the Learning Sample
Task Value Task Interest Arithmetic Scores BPRS Total BPRS Neg BPRS Pos CPT-IP WRAT3 Vocabulary
Note: PCS, Perceived Competence Scale; BPRS Total, Brief Psychiatric Rating Scale-Expanded Version total score; BPRS Neg, Brief
Psychiatric Rating Scale-Negative Symptoms Factor; BPRS Pos, Brief Psychiatric Rating Scale-Positive Symptoms Factor; CPT-IP,
Continuous Performance Test-Identical Pairs Version, d#; WRAT3 Reading, Wide Range Achievement Test-Third Version, Reading
subtest standard score; WAIS-R Vocabulary, Wechsler Adult Intelligence Scale-Revised, Vocabulary subtest scaled score.
*P < .05.
**P < .01.
Table 1. Demographic and Clinical Characteristics of the Whole
Sample, (N = 70)
Age (y)38.54 (5.67)
Education (y)11.42 (4.16)
Gender, male (%)62
Duration of illness (y)12.11 (6.98)
Percentage on atypicals 85
Percentage on anticholinergics15
Percentage diagnosed disorganized type6
Percentage diagnosed with
Premorbid IQ estimate
Note: BPRS, Brief Psychiatric Rating Scale-Expanded Version
total score and 4-factor solution; WRAT-3, Wide Range
Achievement Test-Third Edition; WAIS, Wechsler Adult
Expectancy Theory and Persistence
scores for other measures to examine PCS changes in the
context of other variables. As can be seen in table 4, sig-
nificant improvements in arithmetic ability from baseline
to posttraining (t = 3.45, P = .01) did not significantly de-
crease at 3 months (t = 1.12, P = .10). Only self-compe-
tency followed this same pattern of improvement and
persistence in learning following treatment. Task interest
showed improvement at posttreatment (t = 2.34, P = .04),
but the effects were lost at 3 months (t = 2.17, P = .04).
Changes in task value from baseline to posttraining or
baseline to 3 month were nearly significant (P’s = .06–
.07), with the slight gains at post maintained at 3 months
(t = 1.04, P = .19). There were no significant changes in
symptoms or any other variables from baseline to post to
3-month follow-up (P’s >.19).
We foundthatself-competencyforalearning taskwas sig-
nificantly related to the value the individual attributed to
and at posttraining as well as 3-month follow-up. In other
words, if the task was perceived as useful or worthwhile to
the person, there were greater expectations of success for
were related to greater persistence of learning effects at
follow-up, even after accounting for baseline task per-
and task value. These findings are in accordance with ex-
pectancy-value theory, which posits that expectations of
success and the value placed on a learning task are central
determinants of motivation to learn and indicate that this
theory can be expanded to individuals with schizophrenia.
These findings also advance the emerging evidence that
performance beliefs play a vital role in the relationship
between neurocognition, motivation, and learning in
Table 3. Results of the Hierarchical Block Regression Predicting
Postarithmetic Ability at 3 Months
Learning condition.28 2.24.05
Baseline arithmetic ability
Baseline arithmetic ability
Baseline arithmetic ability
Baseline arithmetic ability
Baseline arithmetic ability
Note: Learning conditions (motivational instruction or control
learning instruction); CPT-IP, Continuous Performance Test-
Identical Pairs; Task Interest and Task Value subscales of the
Intrinsic Motivation Inventory for Schizophrenia Research.
Step 1: R2= .41, F = 16.57, P < .05.
Step 2: R2= .44, F = 4.48, P < .05; R2change = .03, significance
of R2change = .09.
Step 3: R2= .44, F = 4.12, P < .05; R2change = .00, significance
of R2change = .75.
Step 4: R2= .46, F = 3.68, P < .05; R2change = .02, significance
of R2change = .11.
Step 5: R2= .50, F = 3.25, P < .05; R2change = .04, significance
of R2change = .07.
Step 6: R2= .59, F = 5.31, P < .05; R2change = .09, significance
of R2change = .00.
Table 4. Scores at Baseline, Posttesting, and 3-Month Follow-up
for the Whole Learning Sample
Sample, (N = 70)
Arithmetic ability (total correct 0–60)
Perceived self-competency (4–28)
Task interest (7–49)
Task value (7–49)
Note: Abbreviations are explained in the first footnote to table 2.
aChange in mean differences from baseline is significant at P <
bNo significant mean differences from posttesting to 3 month-
follow-up at P > .05.
J. Choi et al.
task does not present any obvious benefit to the partici-
sen because it is a difficult learning task where goals and
in cognitive remediation tasks. Participants were paid for
theassessmentsbutnotforthetraining sessions, thus min-
imizing any influence of external reward for the exercises.
Descriptively, participants reported little interest in doing
the task at baseline, which is expected given the mundane
content of the exercises (use of parentheses, order of oper-
ations). However, even in the context of low interest and
no external reward, we found that baseline expectation of
success—the perception that they could do the tasks—was
the most important factor in explaining how much was
retained 3 months after the end of training. This becomes
particularly important when one considers that these find-
ings hold true when prior arithmetic skill and elementary
cognitivefunctionwereaccounted for.Ourresultshelp ex-
plain the relationship between learning and motivation by
highlightingthe importance ofassessing andinstilling self-
efficacy for challenging cognitive tasks in order to influ-
ence how well patients learn and how much they retain.36
Similar to the nonpsychiatric population, people with
schizophrenia must believe their actions can lead to pos-
itive outcomes orelse theymayhavelittle incentive totake
on challenging treatment tasks.37,38
Our results also indicate that expectations of success
(perceived self-competency) improve following training
and that these improvements are sustained at 3-month
follow-up. This pattern of changes mirrors that observed
for learning arithmetic, highlighting the important rela-
tionship between perceived self-competency and learn-
ing. Our findings not only show the interrelatedness of
learning effects and self-competency but also suggest
a promising potential target for intervention in cognitive
remediation programs—by structuring treatments in
a way that increases self-competency, learning effects
may be enhanced. In our earlier work, we reported on
one potential method of increasing self-competency
and subsequent learning effects. Compared with a stan-
dard arithmetic learning task without learning cue
manipulations, increasing IM for the learning task by
manipulating social contexts—linking the task to per-
sonal goals and providing experiences of enjoyment, con-
trol, andmastery—led to
patients understand the value of a training activity by
linking it to their personal goals and proceeding with
the training in a way that provides them with experiences
of enjoyment, control, and mastery is both consistent
with the philosophy of recovery-based approaches39
and supported by the data presented here.
Although this study examined the impact and mallea-
bility of self-efficacy solely in the context of a cognitive
learning exercise, the findings have potential implica-
tions for other learning-based therapeutic interventions.
Psychosocial programs for people with schizophrenia
are typically predicated on the notion that skills can
be taught to help people reach their functional goals.40
Thus, much of the therapy in psychosocial programs
involves learning-based activities.41–43For example,
psychosocial programs teach social skills, wellness,
symptom management, and vocational skills with the
expectation that patients will learn the material and ap-
ply it in everyday life.44–46The findings presented here
emphasize the importance of patients valuing the skill
and believing that they will be competent at learning
the skill. We believe that promoting expectations of suc-
cess in traditional psychosocial rehabilitation programs
and other learning-based therapeutic programs may
lead to higher perceived self-competency and, subse-
quently, greater learning effects and greater overall ben-
efit from these programs.
There are several limitations to the current study.
While respectable, our sample size remains too small
to run theta estimates, which would have allowed us to
investigate item response vectors in our self-report meas-
ures. The use of self-report measures in schizophrenia to
tap into psychological constructs has its disadvantages
compared with objective or clinician-ratedmeasures47–49;
however, there is also evidence that self-reports are
equally valid instruments to measure abstract constructs
in schizophrenia.50Additionally, given the nature of the
psychological constructs studied, interview-based instru-
ments may not accurately gauge a person’s perspective of
task value or enjoyment.
Future research is needed to investigate whether per-
ceptions of task value can be enhanced through psycho-
therapy techniques as well as examine what components
of task value are related to self-competency. In addition
to self-competency, related psychological variables such
as self-esteem have also been found to be related to
learning, with interventions focusing on training in cog-
nitive strategies associated with improvements in self-
esteem. Unlike our current results regarding self-compe-
tency, these self-esteem improvements appear to only
occur during participation in the training task itself
and are attenuated at follow-up.51,52Nevertheless, these
findings underscore the intermingled nature of self-
psychological constructs that influence learning and
the potential to profit from cognitive remediation train-
ing or other therapeutic programs. In order to maximize
treatment engagement and benefits, we must continue
exploring how to address these psychological factors,
as they seem to be directly related to functional
MH071733-01A2 to J.C. and A.M.).
Expectancy Theory and Persistence
Drs J.C., J.M.F., and A.M. would like to thank Jennifer
Scagliotti, MA, Kellie Smith, MA, Katie Tobin, PhD,
and Gennarina Santorelli for their assistance in data
entryand data collection.
Mental Health had no further role in study design; in
the collection, analysis, and interpretation of data; in
the writing of the report; and in the decision to
submit the paper for publication. The authors have
declared that there are no conflicts of interest in
relation to the subject of this study.
1. Brekke J, Kay DD, Lee KS, Green MF. Biosocial pathways
to functional outcome in schizophrenia. Schizophr Res.
2. Green MF. What are the functional consequences of neuro-
cognitive deficitsin schizophrenia?
3. Harvey PD. Managing cognitive deficits and functioning in
patients with schizophrenia. J Clin Psychiatry. 2007;68(9):e21.
4. Gard DE, Fisher M, Garrett C, Genevsky A, Vinogradov S.
Motivation and its relationship to neurocognition, social cog-
nition, and functional outcome in schizophrenia. Schizophr
5. Kurtz MM, Seltzer JC, Fujimoto M, Shagan DS, Wexler BE.
Predictors of change in life skills in schizophrenia after cogni-
tive remediation. Schizophr Res. 2009;107(2–3):267–274.
6. Ventura J, Hellemann GS, Thames AD, Koellner V, Nuech-
terlein KH. Symptoms as mediators of the relationship
between neurocognition and
schizophrenia: a meta-analysis. Schizophr Res. 2009;113(2–3):
7. Nakagami E, Xie B, Hoe M, Brekke JS. Intrinsic motivation,
neurocognition, and psychosocial functioning in schizophre-
nia: testing mediator and moderator effects. Schizophr Res.
8. Horan WP, Rassovsky Y, Kern RS, Lee J, Wynn JK, Green
MF. Further support for the role of dysfunctional attitudes in
models of real-world functioning in schizophrenia. J Psychiatr
9. Granholm E, Verney SP, Perivoliotis D, Miura T. Effortful
cognitive resource allocation and negative symptom severity
in chronic schizophrenia. Schizophr Bull. 2007;33:831–842.
10. Grant PM, Beck AT. Defeatist beliefs as a mediator of cogni-
tive impairment, negative symptoms, and functioning in
schizophrenia. Schizophr Bull. 2009;35:798–806.
11. Rector NA. Dysfunctional attitudes, symptom expression in
schizophrenia: differential associations with paranoid delu-
sions and negative symptoms. J Cogn Psychother. 2004;18:
12. Deci EL, Eghrari H, Patrick BC, Leone DR. Facilitating
internalization: the self-determination theory perspective.
J Pers. 1994;62(1):119–142.
13. Schunk DH. Social Cognitive Theory and Self-Regulated
learning. Mahwah, NJ: Lawrence Erlbaum Associates Pub-
14. Dweck CS, Mangels JA, Good C. Motivational effects on at-
tention, cognition, and performance. In: Dai DY, Sternberg
RJ, eds. Motivation, Emotion, and Cognition: Integrative
Perspectives on Intellectual Functioning and Development.
Mahwah, NJ: Erlbaum; 2004:41–55.
15. Bandura A, Schunk DH. Cultivating competence, self-
motivation. J Pers Soc Psychol. 1981;41:586–598.
16. Bandura A. Going Global With Social Cognitive Theory: From
Prospect to Paydirt. Mahwah, NJ: Lawrence Erlbaum Asso-
ciates Publishers; 2006.
17. Eccles JS, Wigfield A. Motivational beliefs, values, and goals.
Annu Rev Psychol. 2002;53(1):109–132.
18. Schunk DH, Zimmerman BJ. Self-Regulation of Learning and
Performance: Issues and Educational Applications. Hillsdale,
NJ: Lawrence Erlbaum Associates, Inc; 1994.
19. Medalia A, Choi J. Cognitive remediation in schizophrenia.
Neuropsychol Rev. 2009;19:353–364.
20. Choi J, Medalia A. Intrinsic motivation and learning in a
schizophrenia spectrum sample. Schizophr Res. 2010;118(1–3):
21. Dweck CS. The development of ability conceptions. In:
Wigfield A, Eccles JS, eds. The development of achievement
motivation. New York: Academic Press; 2002:57–83.
22. Gold JM, Waltz JA, Prentice KJ, Morris SE, Heerey EA. Re-
ward processing in schizophrenia: a deficit in the representa-
tion of value. Schizophr Bull. 2008;34:835–847.
23. First MB, Spitzer RL, Gibbon M, Williams JB. Structured
Clinical Interview for DSM-IV Axis I Disorders—Patient Edi-
tion (SCID-I/P, Version 2.0). New York: Biometrics Research
Department, New York State Psychiatric Institute; 1996.
24. Wechsler D. WAIS-Revised Manual: Wechsler Adult Intelli-
gence Scale-Revised. San Antonio, TX: Psychological Corpo-
25. Wilkinson GS. Manual for the Wide Range Achievement Test-
Third Edition. Wilmington, DE: Pearson Education, Inc; 1993.
26. Cornblatt BA, Risch NJ, Faris G, Friedman D, Erlenmeyer-
Kimling L. The Continuous Performance Test, identical pairs
version (CPT-IP): I. New findings about sustained attention
in normal families. Psychiatry Res. 1988;26:223–238.
27. Plant RW, Ryan RM. Intrinsic motivation and the effects of
self-consciousness, self-awareness, and ego-involvement: an
investigation of internally controlling styles. J Pers. 1985;53:
28. Choi J, Mogami T, Medalia A. Intrinsic Motivation Inven-
tory (IMI): an adapted scale for schizophrenia research.
Schizophr Bull. April 21, 2009; doi:10.1093/schbul/sbp030.
29. Deci E, Ryan R. Intrinsic Motivation and Self-Determination
in Human Behavior. New York: Springer-Verlag; 1985.
30. Markland D, Hardy L. On the factorial and construct validity
of the Intrinsic Motivation Inventory: conceptual and opera-
tional concerns. Res Q Exerc Sport. 1997;68(1):20–32.
31. McAuley E, Duncan T, Tammen VV. Psychometric proper-
ties of the Intrinsic Motivation Inventory in a competitive
sport setting: a confirmatory factor analysis. Res Q Exerc
32. Williams GC, Deci EL. Supporting autonomy to motivate
glucose control in patients with diabetes. Diabetes Care.
33. Overall JE, Gorham DR. The Brief Psychiatric Rating Scale.
Psychol Rep. 1962;10:799–812.
34. Ventura J, Nuechterlein KH, Subotnik KL, Gutkind D,
Gilbert EA. Symptom dimensions in recent-onset schizophre-
nia and mania: a principal components analysis of the 24-item
Brief Psychiatric Rating Scale. Psychiatry Res. 2000;97(2–3):
J. Choi et al.
35. Kopelowicz A, Ventura J, Liberman RP, Mintz J. Consis- Download full-text
tency of Brief Psychiatric Rating Scale factor structure across
a broad spectrum of schizophrenia patients. Psychopathology.
36. Barch DM, Yodkovik N, Sypher-Locke H, Hanewinkel M.
Intrinsic motivation in schizophrenia: relationships to cogni-
tive function, depression, anxiety, and personality. J Abnorm
37. Medalia A, Freilich B. The NEAR model: practice principles
and outcome studies. Am J Psychiatr Rehabil. 2008;11(2):
38. Medalia A, Revheim N, Herlands T. Cognitive Remediation
for Psychological Disorders. New York, NY: Oxford Univer-
sity Press; 2009.
39. Twamley EW, Savla GN, Zurhellen CH, Heaton RK, Jeste
DV. Development and pilot testing of a novel compensatory
cognitive training intervention for people with psychosis. Am
J Psychiatr Rehabil. 2008;11(2):144–163.
40. Mueser K, Bond GR, Foster FR, Lynde D. Psychosocial and
rehabilitation treatments for patients with severe mental ill-
ness. CNS Spectr. 2004;9:891.
41. Kurtz MM, Mueser KT. A meta-analysis of controlled re-
search on social skills training for schizophrenia. J Consult
Clin Psychol. 2008;76:491–504.
42. Roder V, Brenner HD, Muller D, et al. Development of spe-
cific social skills training programmes for schizophrenia
patients: results of a multicentre study. Acta Psychiatr Scand.
43. Twamley EW, Padin DS, Bayne KS, Narvaez JM, Williams
RE, Jeste DV. Work rehabilitation for middle-aged and older
people with schizophrenia: a comparison of three approaches.
J Nerv Ment Dis. 2005;193:596–601.
vocational rehabilitation. Psychiatr Rehabil J. 2008;31:
45. Kern RS, Liberman RP, Kopelowicz A, et al. Applications of
errorless learning for improving work performance in persons
with schizophrenia. Am J Psychiatry. 2002;159:1921–1926.
46. Wexler BE, Bell MD. Cognitive remediation and vocational
rehabilitation for schizophrenia. Schizophr Bull. 2005;31:
47. Iancu I, Poreh A, Lehman B, Shamir E, Kotler M. The
Positive and Negative Symptoms Questionnaire: a self-
report scale in schizophrenia. Compr Psychiatry. 2005;46(1):
48. Medalia A, Thysen J, Freilich B. Do people with schizophre-
nia who have objective cognitive impairment identify cogni-
tive deficits on a self report measure? Schizophr Res.
49. Bowie CR, Twamley EW, Anderson H, Halpern B, Patterson
TL, Harvey PD. Self-assessment of functional status in
schizophrenia. J Psychiatr Res. 2007;41:1012–1018.
50. Bell M, Fiszdon J, Richardson R, Lysaker P, Bryson G. Are
self-reports valid for schizophrenia patients with poor insight?
Relationship of unawareness of illness to psychological self-
report instruments. Psychiatry Res. 2007;151(1–2):37–46.
51. Wykes T, Reeder C, Corner J, Williams C, Everitt B. The
effects of neurocognitive remediation on executive processing
in patients with schizophrenia. Schizophr Bull. 1999;25:
52. Wykes T, Reeder C, Williams C, Corner J, Rice C, Everitt B.
Are the effects of cognitive remediation therapy (CRT)
durable? Results from an exploratory trial in schizophrenia.
Schizophr Res. 2003;61(2–3):163–174.
SR,Wykes T.Cognitive remediation and
Expectancy Theory and Persistence